The nurse is caring for a child with severe head trauma after a car accident. Which is an ominous sign that often precedes death?
a. Papilledema
b. Delirium
c. Doll's head maneuver
d. Periodic and irregular breathing
ANS: D
Periodic or irregular breathing is an ominous sign of brainstem (especially medullary) dysfunction that often precedes complete apnea. Papilledema is edema and inflammation of optic nerve. It is commonly a sign of increased ICP. Delirium is a state of mental confusion and excitement marked by disorientation for time and place. The doll's head maneuver is a test for brainstem or oculomotor nerve dysfunction.
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Represent type of accident or violence with specific agent/circumstance under main term
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